In Sickness and in Health

A number of years ago Christie and I built our dream home, only to discover it was not a dream and certainly didn’t feel like a home. Complications in building, the size of the home, and the location turned out to be disquieting for us. So we went on a search to find home once again.

What began as a challenging task soon turned into an adventure, something both Christie and I like to do. We enjoy house hunting, and this was no exception.

After finding several homes that suited our tastes but not our pocketbooks, our Realtors, Mike and Robin, took us down a twisting and turning “Alice in Wonderland” lane to the water’s edge.

“It’s small,” Mike said, smiling. “But the view of Seattle is to die for, and David, you can practically launch your kayak from your front door. Can you handle that?”

Mike and Robin unlocked the door and stepped aside, allowing us to enter and take in our first glimpse of this 1920s cottage. While our former home was large and pretentious, this cottage screamed, “Come live in me!”

Simple and charming, the home seemed just the right size. This was the penultimate cottage on the lane, complete with sitting area facing the water, stone fireplace, and cozy bedroom upstairs.

Did this explain what was happening to Janine? I believe so. As I reviewed Janine’s history, I saw clearly that she had been raised to be an achiever. Her parents were both professionals and expected her to be a professional woman, to ignore her feelings and perform—and perform she did.

We all want to be well. As the saying goes, “You can have everything, but if you don’t have your health, you have nothing.”

I am working with a man, Charles, who has more money than he can ever spend. He has the finest clothes, the most incredible home, the newest luxury car, and a concierge physician ready to help him with his myriad health issues. Still, because he doesn’t have his health, he spends most days sitting home essentially waiting to die.

Charles is not suicidal, but he has lost his health and his will to really live. He is significantly overweight, suffers from high blood pressure, and uses food to ease his pain. Lost in his small world of food, he is unhappy, lethargic, and discouraged.

Living in an embittered marriage has left him cranky. He says he and his wife live separate lives, having argued for years, and now choose to simply live as “roommates.” Did his wife make him cranky, or has he made his wife unhappy? The interplay between his health, marriage, and mental health is clear—he is not dealing with problems effectively and is coping in some very primitive ways. He is not a happy man.

While most of my clients suffering from stress and emotional abuse and in their relationships are women, there are men, too, who suffer from stress and emotional abuse.

Charles is passive, lonely, and isolated. He is doing little to change his life or actively work on his weight or blood pressure. Caught in an endless pattern of tiredness, excessive weight, and stress eating, he listens only superficially to the counsel of his physician. “Of course I know I need to exercise and eat differently to lose weight,” he shared with me, “but I am not motivated to do it. It’s a vicious circle—the more weight I gain, the worse I feel, and the worse I feel, the more weight I gain.”

“Everyone has ‘the answer’ for me too,” he said. “Everyone thinks it should be so easy to lose weight.”

From a Physician: Dr. Tyson Hawkins, Internist

“Tell me about yourself.”

This is a pretty common opening line when I first meet a patient. It is meant to be vague and open-ended, leaving room for the patient to talk about what they do for work, their family, their upbringing, their hobbies, or their medical history. While we as physicians care about the patient as a person, we also understand that you are there for a reason. We understand it is not a social call. We’re ultimately looking for a list of medical diagnoses and current ailments that will help frame the patient and guide the direction of our visit. We are unintentionally asking patients to identify themselves by their past and current health conditions.

It is always interesting to hear how patients answer this question. Some patients lead by saying, “I know I’m fat and that a lot of my medical problems would probably get better if I lost some weight.” Others might simply say, “I work for the transit authority and have three kids.” The way they answer this simple question says a lot about them and how they identify (or don’t identify) themselves with their disease.

Let’s take the obese patient as an example. When I probe deeper into their struggles with weight, I am not surprised to hear about their personal challenges with stress. Often it can be a history of abuse, whether emotional, physical, or sexual. It can be their marriage. It can be their kids. It can be their parents, or their job. One thing is certain, though—there is always a stressor. They will go on to talk about how they eat because it makes them feel better, or that they do not have enough energy to exercise. Or that exercise hurts. When somebody lives with a condition long enough, I believe they start to identify themselves with the condition. They are one and the same. It becomes harder and harder to separate the person from the condition.

I met Bill five years ago. He was transferring care to me after his previous primary care provider retired. He was morbidly obese with a body mass index greater than 50, with multiple coconcurring conditions, including poorly controlled type II diabetes, hypertension, sleep apnea, and chronic lymphocytic leukemia (CLL). He was gruff, to say the least, and had burned bridges with previous care providers and staff due to his attitude. At one point he was asked to fill out a behavioral contract.

Bill identifies himself by his obesity and as a victim of other people’s prejudice. He blames the way he feels on his obesity but is angry when others do so. Instead of searching for the underlying cause of his overeating and food addiction, he spends his energy on anger and indignation. He is always looking to pick a fight. I don’t know for sure what started Bill on this downward spiral of unhealthy habits, but I do know that his attitude plays a big role in keeping him there.

Bill’s low point came several years ago when his wife passed away; and he has been a different man since. He has been more vulnerable and willing to discuss his feelings more openly. He admits that his weight and his many medical problems scare him. He is now much more willing to ask for help.

I believe Bill has been defined by his illness—obesity. He is fed up with everybody telling him he needs to lose weight and blaming how he feels on his physique. He has spent many years making others feel guilty for judging him. I believe he has been afraid to look at the deeper issues, insecurities, and fears, and instead has found it safer to focus on how others have treated him. This attitude only served to worsen the quality of his medical care, not improve it.

When asking my patients about their deeper pain, anxieties, or current stressors, I sometimes hear patients tell me that dealing with their stress and anxiety is just too hard. They are seeking an easier way, and often that leads to unhealthy habits. Overeating is a common one, and an easy one to identify; it’s hard to hide your weight. But people manage their stress and anxieties in many ways that are less overt. They might admit when confronted, however, that they are too afraid to pursue the root cause of their symptoms. They recognize their coping mechanisms are unhealthy, but they are afraid to dig deeper. Identifying themselves by their illness has allowed them to ignore their deeper hurt and pain.

Persistent painful feelings are not part of a healthy sense of Self or a healthy relationship.

Reflecting again upon Janine and Charles’s life, what are some of their Self-destructive misbeliefs?

Can you see how each of these misbeliefs led them into feeling even more anxiety and confusion? What can they say to lead themselves back to sure footing?

•“Anyone would feel confused if they struggled with my husband/wife and family.”